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Active Liver Bleed Caught During FAST Exam from Spontaneous Hemangioma Rupture: A Case Report
Raul Rodriguez1, Nicole Aviles1
1HCA Florida Kendall Hospital, Department of Emergency Medicine, Miami, Florida.
Clinical Practice and Cases in Emergency Medicine
|February 4, 2025
Summary
Point-of-care ultrasound (POCUS) during a Focused Assessment with Sonography in Trauma (FAST) exam can detect solid organ injury, such as active liver bleeding, in hypotensive patients. This case demonstrates POCUS
Area of Science:
- Emergency Medicine
- Radiology
- Critical Care Medicine
Background:
- The Focused Assessment with Sonography in Trauma (FAST) exam is a standard tool for evaluating trauma patients.
- Point-of-care ultrasound (POCUS) has advanced beyond detecting free fluid in trauma evaluations.
- Skilled sonographers can identify specific solid organ injuries during a FAST exam.
Observation:
- A 55-year-old male with rib fractures presented with syncope and was diagnosed with pulmonary embolism.
- The patient subsequently developed hypotension, encephalopathy, and unresponsiveness.
- A FAST exam revealed free fluid and active bleeding around the liver.
Findings:
- Computed tomography confirmed an active subcapsular liver bleed.
- The patient had a ruptured liver hemangioma.
- Emergency surgery and hepatic arterial embolization were performed.
Implications:
- This case highlights POCUS utility in undifferentiated hypotension and shock beyond trauma.
- It underscores the importance of not anchoring on an initial diagnosis.
- Ultrasonographic competency is crucial for physicians across all specialties.
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